title: Transoral robotic surgery experience in 44 cases.
abstract: OBJECTIVE
  To report a single institution's experience with transoral robotic surgery (TORS) and its clinical outcomes. This was a retrospective study carried out at a university-affiliated teaching hospital.
  
  
  METHODS
  Forty-four consecutive TORS patients with benign and malignant diseases were reviewed. Data on demographics, clinical parameters, and diet were collected. Surgical margins, local and regional recurrence, distant metastasis, 2-year disease-free survival rate, and 2-year survival data were reviewed for the malignant cases.
  
  
  RESULTS
  Nine benign and 35 proven squamous cell carcinoma (SCCA) cases underwent TORS. The set-up time was 17.12 minutes (range, 10-40 minutes), and operative time was 53 minutes (range, 10-300 minutes). Average length of stay was 2.5 days. There were seven (6.8%) grade 3 surgical complications. Surgical infection rate was 2.3%. Benign cases were on a regular diet after TORS. Of the malignant cases, 94% were taking peroral diet immediately after the TORS procedure. There were no intraoperative complications and no 30-day postoperative mortalities. The mean follow-up time was 25.2 months (range, 16-38 months) for malignant disease. The SCCA sites were in the oropharynx (30/35), larynx (2/35), and unknown primary with neck metastasis (3/35). Unknown primary patients were excluded in the surgical margin analyses. Negative margins were achieved in 91% of cases. The local and regional recurrence rates were 6.3% (2/32) and 3.1% (1/32), respectively. Two patients (6.3%) developed distant metastasis. Oropharyngeal SCCA cases were reviewed, of which 23 were human papillomavirus (HPV)/p16 positive and 7 were HPV/p16 negative. The 2-year actual survival for HPV-positive and -negative patients was 96% (22/23) and 86% (6/7), respectively. The 2-year disease-free survival for HPV-positive and -negative cases was 91% (21/23) and 71.4% (5/7), respectively. All malignant cases that underwent TORS received postoperative adjuvant therapy.
  
  
  CONCLUSIONS
  TORS is a safe procedure with minimal complications and acceptable clinical and functional outcomes.
authors.affiliation: 1 Johns Hopkins Head and Neck Surgery , Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland.
authors.forename: Ray G F
authors.initials: RG
authors.lastname: Blanco
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Ha
authors.forename: Keri
authors.initials: K
authors.lastname: Ryniak
authors.forename: Barbara
authors.initials: B
authors.lastname: Messing
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Califano
authors.forename: John R
authors.initials: JR
authors.lastname: Saunders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D019647:Oral Surgical Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D012371:Robotics; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult